Hepatic myelopathy, also known as portacaval shunt myelopathy, is a specific type of neurological complication of liver disease. It is characterized by slowly progressive, spastic paraplegia with predominantly demyelinating pathological changes in the lateral and posterior cords of the spinal cord. This disease occurs most often in the decompensated phase of cirrhosis, with prominent manifestations of hepatic decompensation and portal hypertension. Most patients have recurrent upper gastrointestinal bleeding, after portal vein shunts and splenorenal vein anastomoses, mostly surgical or naturally formed portacaval circulation shunts, and most cases coexist with hepatic encephalopathy.